What is Encephalitis (Chamki Bukhar)? - Seeker's Thoughts

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What is Encephalitis (Chamki Bukhar)?



Acute Encephalitis Syndrome or Japanese Encephalitis which is also locally known as (chamki bukhar), brain fever has broken out in Muzaffarpur District of North Bihar. This deadly fever took children's lives. However, according to the unofficial record,  there are more than 200 deaths due to Encephalitis syndrome.


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Many children were admitted in several hospitals and over 200 have already died in June 2019. 


Encephalitis outbreak history in India

The first major epidemic caused by JEV was reported from Burdwan and Bankura districts of West Bengal in 1973 followed by another in 1976. In the 1973 outbreak, 700 cases and 300 deaths were reported.
Over 400 children died in the last decade due to this life-threatening fever.

The worst outbreak was in 2012 when 120 children reportedly died. Over 90 children died altogether in 2014, according to the research carried by the Lancet Global Health established the connection between litchi consumption and encephalitis deaths.

Every year during summer time, especially in the season of luscious fruit Litchi, Acute Encephalitis syndrome outbreaks get reported and takes the lives of children in India's largest litchi cultivation region.










Outbreaks in the north and eastern India have been linked to children eating unripe litchi fruit on empty stomachs. Unripe fruit which contains toxins.



What is the time when JEV to spread?

According to doctors, high temperature during summer, along with humidity more than the normal, is considered to be an ideal situation for the outbreaks of Encephalitis.



What is the connection of Encephalitis syndrome with Litchi fruit?

Litchi may be the culprit causing acute encephalitis syndrome, which affects children in north India during summer time.
The chemicals and substances that fruit carry is similar to those found in Jamaican fruit, ackee, which is the cause of a childhood (under 15) acute encephalopathy disease called Jamaican vomiting sickness. 


It was a clinical feature of ackee poisoning. 
This includes early morning onset, encephalopathy, hypoglycemia, and high case fatality. A toxic substance methylenecyclopropyl - alanine (MCPA), also called hypoglycin A, is present in unripe ackee, whose consumption leads to depletion of glucose levels in the child's body. 



Since brain cells require a constant supply of glucose, this depletion triggers abnormalities in the brain too. A variant of hypoglycin A, namely methylenecyclopropyl-glycine (MCPG), is found in litchi and its consumption reduces glucose levels in the body.



It was concluded that litchi consumption can be directly related to acute encephalitis syndrome in Bihar and Muzaffarpur. 



Another study published in journal epidemiology and infection shows that in some cases of encephalitis syndrome in Jharkhand and Odisha, the viral agents (parasites that cause the disease were that of dengue and measles.

Over 16% of cases were found to be caused by viral agents identified to be herpes simplex virus while another 2.6% cases were by measles.



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Signs and Symptoms of Encephalitis



Acute encephalitis syndrome is characterized by an acute onset fever and clinical manifestation that includes mental confusion, disorientation, delirium, or coma. Apart from viral encephalitis, a severe form of leptospirosis and toxoplasmosis can cause Encephalitis syndrome. 



It predominantly affects the population below 15 years. There is seasonal and geographical variation in the causative organism.




Does India lag behind in surveillance system and poor health service?




Surveillance in India remains poor, and the actual disease burden, its distribution, and trends are still now known.

The government is the primary provider of healthcare in many developing countries. despite large budgetary allocations and an extensive network of public health system outcome often remain poor. 

Evidence suggests that extremely high rates of staff absence and resource leakage, enabled by poor systems of accountability, are key reasons that healthcare channels do not function as intended.

Past intervention that only targeted health staff attendance has often been unsuccessful because of a lack of accountability.  

India has a network of over 22,000 public Primary Health Centers to provide basic services such as immunization and antenatal care to the poor. Yet nationwide, healthcare workers in India are absent an average 43% of the time.

 As a result, many citizens coming to receive care leave empty-handed, and end up visiting untrained or unqualified providers for treatment.

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Additionally, leakage of materials and money drain the limited resources from the system.
The absence of real-time, digitized data makes it difficult to receive, process and analyze critical information. This, in turn, makes it difficult to design a fast and effective response to an emerging threat. These issues often contribute to the poor health outcomes that persist despite the comprehensive public healthcare network.

National Health protection scheme

The biggest takeaway from union budget 2018-19 is the National Health Protection Scheme. This is a part of the current government’s Ayushman Bharat project. It is an ambitious scheme which has generated hope and anxiety because it is the world’s largest government-funded healthcare program.

The National Health Protection Scheme has promised to cover 10 crore families involving 50 crore family members with health insurance cover of Rs. 5 lakh for secondary and tertiary hospitalization.
Two flagship initiatives under Ayushman Bharat

Creation of primary healthcare foundation of India which is comprehensive, close to people, provides first level care to people near their houses and launches Jan Andolan for public health care.

To provide people secondary and tertiary care, connect poor and vulnerable population to this system, the scheme is NPS. It is an aspirational scheme covering a significant population of India it builds on previous experiences of similar schemes on a small scale. This is built on several schemes that state governments have launched from time to time.












Conclusion

The frequent outbreaks of several viruses and diseases recently in India took hundreds of lives including children. 

The government should get proactive in the health care sector especially in remote areas where health facilities are least. Acute encephalitis in different parts of the country creates a huge challenge to public health in India. 


Besides demonstrating the vulnerability of the population to emerging infections, the frequent occurrence of acute encephalitis outbreaks with high case fatality, calls for enhanced health system capacity and a focusses approach in responding to such threats and thereby protecting lives of poor and socially vulnerable populations



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